May 1, 2014

Old and New Ways of Handling Doctor Office Visits

We've all been there. Fifteen minutes after leaving a doctor's office, you realize you forgot to ask a question or can't recall instructions she gave you. It's an increasingly common problem as we age. But help may be on the way.

Note-takers for the Patient
Many senior Villages -- the organizations where volunteers provide services to elderly neighbors who want to "age in place" -- are now offering the services of trained note-takers to accompany the senior on his doctor visits and make notes of what's being said.

A  few months ago, USA Today provided this description of how a Washington, DC Village provides this service
It used to be difficult for Edith Couturier, an 85-year-old resident of the District of Columbia, to explain to her adult children on the West Coast all the details of her medical appointments. But now she doesn't go alone — she takes along a volunteer "medical note taker."
"There are four ears listening to what the doctor says," said Couturier.
That second set of ears belongs to Sharon Wolozin, who takes notes the old-fashioned way — with pen and paper — and then reads some of the main points aloud to confirm them with the doctor. If the patient forgets a question she told Wolozin she planned to ask, Wolozin will remind her. But she is not an advocate and has no medical training.
"We don't get between the doctor and the patient," said Wolozin. Her role is only to create an accurate record of what happened at the appointment that she gives to Couturier, who can then share it with her children or others.
I wrote last week  about my decision to become an associate member of the Palisades Village in my neighborhood. I was told they are getting ready to offer this note-taking service to their full members.

Scribes for the Doctor
The note-takers who accompany the elderly to doctors' offices do it the old fashion way: with paper and pen. But doctors are now switching from paper to electronic medical records. Any doctor who doesn't make the switch by 2015 will face Medicare penalties.

Doctors who make the switch must now take notes when examining a patient AND enter those notes into a computer to create a permanent record. Doctors complain that this process makes them focus more on the computer than on the patient. Having experience with this new process, I can add that the patient on the other side of the computer can feel that the doctor is paying more attention to the computer than to him.

Many doctors are beginning to hire medical scribes. Here's how a scribe works with a doctor:

Acting like a court reporter, the scribe is present in the doctors office, as inconspicuously as possible. As the doctor examines a patient, the scribe types notes and speaks into a handheld microphone. Once the scribe finishes the records, he gives them to the doctor for her approval.

This saves the doctor hours of administrative work and allows her to concentrate on patients. One survey found that doctors with scribes were able to see more patients, though the time patients spent in the office didn't decrease.

Scribes require extensive training to fill out the medical records. There are thousands of record systems and scribes need to know how to put in the right billing codes and medical terminology at lightning speed.

The presence of medical scribes raises privacy issues; some patients may not like having another person in the room.

Patient Portals
The federal government is providing doctors with financial incentives to set up patient portals. They offer the kind of access to medical records and to providers that I'd like. So far, only 20 percent of doctors have set them up, but they're expected to grow rapidly.

A patient portal is a secure online website that provides convenient 24-hour access to personal health information and medical records, from anywhere with an internet connection.

The features of patient portals vary. Typically, you can securely view and print portions of your medical record, including recaps from doctor visits, discharge summaries, medications, immunizations, allergies, and most lab results.

Other features may include:
  • Exchanging secure e-mail with your healthcare team
  • Requesting prescription refills
  • Scheduling non-urgent appointments
  • Checking your benefits and coverage
  • Updating your contact information
  • Making payments 
  • Downloading or completing forms
This new process is all well and good, but it doesn't yet include what I'd most like to see . . . and what has the greatest potential for significant cost savings: the ability to substitute email exchanges for office visits. Thus far, insurers require a one-on-one meeting for reimbursement. 

1 comment:

Curtis Pilon said...

You've brought up one advantage that is often overlooked by this: doctors can now concentrate on medical matters, instead of non-medical jobs such as this. This should translate into a more efficient service that would be beneficial to patients. Of course, it would still be best if the people who will handle such records have a background on the medical field, or have been trained forthwith after hiring. I understand your other misgivings on this new setup though, but I fully trust there could be ways to address those concerns.

Curtis Pilon @ Spectrum Information